WHAT IS A NURSE PRACTITIONER?

A nurse practitioner (NP) is a registered nurse (RN) who has completed advanced education and training in the diagnosis and management of common medical conditions, including chronic illnesses. Nurse practitioners provide a broad range of health care services. They provide some of the same care provided by physicians and maintain close working relationships with physicians. An NP can serve as a patient’s regular health care provider.

Nurse practitioners see patients of all ages. The core philosophy of the field is individualized care. Nurse practitioners focus on patients' conditions as well as the effects of illness on the lives of the patients and their families. NPs make prevention, wellness, and patient education priorities. This can mean fewer prescriptions and less expensive treatments. Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NPs. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.

Because the profession is state regulated, care provided by NPs varies. A nurse practitioner's duties include the following:

  • Collaborating with physicians and other health professionals as needed, including providing referrals
  • Counseling and educating patients on health behaviors, self-care skills, and treatment options
  • Diagnosing and treating acute illnesses, infections, and injuries
  • Diagnosing, treating, and monitoring chronic diseases (e.g., diabetes, high blood pressure)
  • Obtaining medical histories and conducting physical examinations
  • Ordering, performing, and interpreting diagnostic studies (e.g., lab tests, x-rays, EKGs)
  • Prescribing medications
  • Prescribing physical therapy and other rehabilitation treatments
  • Providing prenatal care and family planning services
  • Providing well-child care, including screening and immunizations
  • Providing health maintenance care for adults, including annual physicals

Nurse practitioners provide high-quality, cost-effective individualized care that is comparable to the health care provided by physicians, and NP services are often covered by insurance providers. NPs practice in all states. The institutions in which they work include the following:

  • Community clinics and health centers
  • Health departments
  • Health maintenance organizations (HMOs)
  • Home health care agencies
  • Hospitals and hospital clinics
  • Hospice centers
  • Nurse practitioner offices
  • Nursing homes
  • Nursing schools
  • Physician offices
  • Private offices
  • Public health departments
  • School/college clinics
  • Veterans Administration facilities
  • Walk-in clinics

Most NPs specialize in a particular field of medical care, and there are as many types of NPs as there are medical specialties.

NPs and Women's Health
Women with serious conditions, especially those that require surgery, need the services of a physician. But when women have typical health care needs, an NP can serve as the health care provider.

Some nurse practitioners focus specifically on obstetrics and gynecology. They provide services that include the following:

  • Care before and after menopause
  • Contraceptive care
  • Evaluation and treatment of common vaginal infections
  • Health and wellness counseling
  • Midwifery
  • Physical exams, including Pap smears
  • Pregnancy testing and care before, during, and after pregnancy
  • Screening and referral for other health problems
  • STD screening and follow-up

Licensure and Certification
To be licensed as a nurse practitioner, the candidate must first complete the education and training necessary to be a registered nurse (RN).

Requirements for a registered nurse include an associate degree in nursing (ADN), a bachelor of science degree in nursing (BSN), or completion of a diploma program, as well as direct patient care for acutely or chronically ill patients. Associate degree in nursing programs, which are offered by community and junior colleges, usually take 2–3 years. BSN programs are offered by colleges and universities and take 4–5 years and diploma programs are administered in hospitals and usually take 2–3 years. Depending on the program attended, the candidate may fulfill some NP requirements while completing the RN degree.

In most cases, professionals and employers in the field strongly recommend the BSN as a minimal requirement for NPs, and some states require this. To become NPs, most nurses with an ADN or diploma enter a bachelor of science program. They may be able to find a staff nursing position and take advantage of tuition reimbursement programs to work toward a BSN.

Once registered nurse status is attained, the candidate must complete a state-approved advanced training program that usually specializes in a field such as family practice, internal medicine, or women's health. The degree can be granted by any of the following:

  • A community college, which grants an associate in arts degree
  • A hospital-based program, which grants a 3-year diploma
  • A university, which grants a bachelor of science in nursing (BSN) degree

The variety of educational paths for NPs is a result of the history of the field. In 1965, the profession of nurse practitioner was instituted and required a master's degree. In the late 1960s into the 1970s, predictions of a physician shortage increased funding and attendance in nurse practitioner programs. During the 1970s, the NP requirements relaxed to include continuing education programs, which helped accommodate the demand for NPs. Currently, all three educational options to attain NP status are valid.

After completing the education program, the candidate must be licensed by the state in which he or she plans to practice. The State Boards of Nursing regulate nurse practitioners and each state has its own licensing and certification criteria. In general, the criteria include completion of a nursing program and clinical experience. Because state board requirements differ, nurse practitioners may have to fulfill additional requirements, such as certification by the American Nurses Credentialing Center (ANCC) or a specialty nursing organization. The license period varies by state; some require biennial relicensing, others require triennial.

After receiving state licensing, a nurse practitioner can apply for national certification from the ANA or other professional nursing boards such as the American Academy of Nurse Practitioners (AANP). Some NPs pursue certification in a specialty. Several organizations oversee certification, including the following:

  • American Association of Critical-Care Nurses
  • Board of Certification for Emergency Nursing
  • National Certification Board of Pediatric Nurse Practitioners and Nurses
  • National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
  • Oncology Nursing Certification Corporation

A women's health nurse must have experience in direct patient care, education, administration, and/or research. He or she must have graduated from an OB/GYN nurse practitioner program (1-year program that is accepted by the National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties). The NP must also complete a required number of teaching and clinic hours in an OB/GYN setting. The National Association of Nurse Practitioners in Women's Health (NPWH) oversees the accreditation of programs that prepare NPs in women's health.